The Management of Chronic Back Pain in Primary Care Settings: Exploring Perceived Facilitators and Barriers to the Development of Patient-Professional Partnerships.

Supporting patients in forming partnerships with health professionals is the key of effective self-management. This study aimed to explore the nature of patient-professional partnerships and its related factors that create facilitators and barriers to patients' self-management ability. A constructivist grounded theory approach was undertaken. Three main themes emerged: interaction and communication, integrated care, and service and system. A theoretical model was generated that posits effective communication, individualized integrated care, and high-quality service as key influences on the successful development of patient-professional partnerships and patients' ability to self-manage. Giving attention to these factors helps understand the development, implementation, mechanisms, and evaluation of building a patient-professional partnership and maximizes the opportunities for patient self-management of chronic pain. Future research and practice are needed to move beyond a simplistic focus on health outcomes to address the complex links between partnerships and treatment delivery processes, and interventions, effects, and patients' context.

The association between patient-professional partnerships and self-management of chronic back pain: A mixed methods study.

BACKGROUND: Self-management is recommended for patients with chronic back pain. Health professionals' support for self-management can be more effective when working in partnership with patients. The aim of this study was to investigate the associations between patient-professional partnerships and the self-management of chronic back pain. METHODS: An explanatory sequential mixed methods study was undertaken. Adults with chronic back pain referred to pain management clinics participated at baseline and 3-month follow-up. Their pain severity, partnerships with health professionals and self-management ability were measured. Hierarchical linear regression was undertaken to examine the strength of the associations between partnerships and self-management. A subsample was interviewed about experiences of the impact of patient-professional partnerships on their self-management ability, using a grounded theory approach. RESULTS: A total of 147 patients were recruited and 103 (70%) patients completed the follow-up. A strong association (p < 0.001) was detected between patient-professional partnerships and all dimensions of self-management ability. This was validated by interviews with a subsample of 26 patients. Four themes emerged as follows: connecting with health professionals, being supported through partnerships, feeling positive and making progress towards self-management, and acknowledging the impact but feeling no difference. CONCLUSIONS: Developing a partnership in care may improve patients' ability to gain knowledge, manage side effects and symptoms and adhere to treatment. It helped strengthen health professionals' support and produce a sense of safety for patients. Guiding health professionals in building partnerships where expectations are acknowledged and tailored information and support are provided could be considered as part of the standard education and training. SIGNIFICANCE: This study identified and validated strong associations between patient-professional partnerships and self-management. Support for self-management alone may not be sufficient, and building partnerships where patients and professionals work together towards agreed goals make an essential contribution to helping increase patients' ability to self-manage chronic back pain.

End stage renal disease by patients with malignancy--ethical problems.

The problem of co-occurrence of kidney failure, as well as ESRD and malignancy is relatively often and brings a significant therapeutical and moral challenge. The ethical basis of our consideration are "Evangelium Vitae" by John Paul II and "Declaration Jura et Bona". The fundamental choice is whether to start and/or continue the kidney replacement treatment. We present 3 algorithms for the most typical situations. The first ethical postulate in our considerations is that patients with the malignancy of good prognosis should not be denied of any treatment chance and should be dialysed as any other patient. In the situation of patients with neoplastic disease with bad prognosis and ESRD, the question of 'withholding or withdrawing' dialysis is essentially part of a fundamental question, what should be the ultimate goal of medicine? There is no doubt that the person most authorized to take a decision in such a situation is the patient provided it is a conscious decision based on full information. Therefore any decision to cease treatment, even submitted at the public notary, should be verified as long as a conscious contact with a patient is possible. In the situation of continued lack of logical contact with the patient who has not left any clear disposition for such circumstances we must take the decision based on their benefit. It is more than desired that the decision acquires the approval of the patient's family but in the situation when it is not possible the doctor decide. In the doubtful cases we should take decisions "towards life".

[Some ethical and historical aspects concerning placental blood transfusion]. / Kilka refleksji etycznych i historycznych na marginesie przetaczania krwi lozyskowej.

Recently, a greater interest is observed concerning the taking of placental blood in order to use it in future. This article pays attention to some ethical aspects like the ownership of the placenta or the possible commercial problems. We reminded the very first study on placental blood transfusion which took place before the World War II and also other abandoned methods used in transfusion in the past.

[About the beginnings of otolaryngology in Poland in commemoration of the 150th anniversary of Teodor Heryng's birthday and the 100th anniversary of the founding of the first Laryngology Ward in Warsaw]. / O poczatkach otolaryngologii polskiej w 150 rocznice urodzin Teodora Herynga i 100 rocznice powolania pierwszego oddzialu laryngologicznego w Warszawie.

In this study was remain biography of two pioneers of polish laryngology--Teodor Heryng and Leopold Lubliner. The first laryngological subdivision in Warsaw was localised in St. Roch hospital. The first full equipment laryngological division where was open in Jewish hospital.

Particular fractions of microproteinuria in patients with stabile angina pectoris and without a clinical nephropathy.

The determination of microalbuminuria is a valuable method in the diagnosis of renal and vascular diabetes or hypertension complications. Recently, microalbuminuria appeared to be the predictor of coronary heart diseases (CHD). The presented study comprised 26 patients with stable angina pectoris (AP) and 27 healthy volunteers. We simultaneously evaluated microproteinuria during the first morning and afternoon miction and the 24-h blood pressure. Amongst patients with AP all urine protein concentrations were increased (results in g/mol creatinine): alpha-1-microglobulin (1.04 + 0.13 vs. 0.47 + 0.05, p < 0.001) albumin (0.95 + 0.15 vs. 0.61 + 0.05, p < 0.05) and IgG (1.00 + 0.17 vs. 0.55 + 0.05, p < 0.01) were higher, in comparison to control group values. Indices for diurnal blood pressure rhythm were significantly lower in the AP group for both systolic (1.07 + 0.01 vs. 1.14 + 0.01 p < 0.001) and diastolic (1.09 + 0.02; vs. 1.21 + 0.03 p < 0.01) pressures. A physiological increase of albumin from the afternoon sample was only observed in the control group. Thus, our AP patients demonstrated signs of subclinical nephropathy in both the proximal tubuli and glomeruli.

Does moxonidine increase cytotoxic activity of ethanol in rats? Preliminary report on the base of the ultrastructural study.

Combined effects of moxonidine and ethanol on ultrastructure of selected Wistar-Kyoto rat organs (kidney, liver, heart) were investigated. In cells of the animals, which received moxonidine alone, no morphological changes were found. In the group of rats which received alcohol, several typical submicroscopical changes were found, especially related to the mitochondria. After the combined administration of ethanol and moxonidine the pathological changes were bigger than those found in animals which received alcohol alone. Those changes were particularly significant in kidney and liver. The results might indicate that moxonidine increased cytotoxic activity of ethanol on several organs in rats.

Day/night ratio of microproteinuria and blood pressure rhythm in type II diabetes.

The paper discusses the results of the studies conducted with a group of patients with type II diabetes without clinical nephropathy. The aim of the study was to attempt to determine the markers for early stages of diabetic nephropathy in NIDDM patients. The following examinations were carried out: the level of selected microproteinuric components, 24 h monitoring of arterial blood pressure, and electrocardiogram (ECG). Among the patients examined, the level of alfa-1-microglobulin, albumin and immunoglobulin G (IgG) in diabetic patients was higher than in the control group, and the increased activity of beta NAG was observed. The 24 h profile of blood pressure and the ratio afternoon/night of albumin excretion flattened in the majority of diabetic patients. The results of the study suggest that the proximal tubules and the membranes of renal glomeruli are damaged as early as during the period of subclinical diabetic nephropathy.

[Microproteinuria and circadian rhythm of blood pressure in patients with arterial hypertension]. / Mikroproteinuria i rytm dobowy cisnienia u pacjentów z nadcisnieniem tetniczym.

Microproteinuria is a recognized sign of early nephropathy in the course of arterial hypertension. There is few data concerning the excretion of proteins other than albumin in this group of patients. The aim of the study was to examine circadian rhythm of alfa-l-microglobulin (AlMG), albumin (ALB), immunoglobulin G (IgG) excretion and N-acetyl-beta-glukosaminidase (beta NAG)-activity, then to compare the results with the results of 24 hour ambulatory monitoring of arterial blood pressure in patients with arterial hypertension. The study comprised 28 patients. The control group included 27 healthy volunteers. Albumin concentration was determined by Beckman ICS2 nephelometer, using Beckman and Dako reagents. Blood pressure and ECG were monitored by analysis with ABP-system (AMP-USA). In patients with arterial hypertension significantly higher levels of ALB, AlMG, IgG and increased beta NAG activity were observed in morning urine samples. Despite hypotensive treatment blood pressure values were slightly, though significantly higher than in the control group. Among patients in the study circadian BP rhythm was disturbed. The results obtained suggest that in this group of patients subclinical nephropathy develops involving renal glomeruli and proximal tubules--probably resulting from vascular and humoral disorders, with accompanied hypertension.

[Evaluation of the accuracy of arterial pressure measurements with different types of devices used for self-monitoring]. / Ocena dokladnosci pomiarów cisnienia tetniczego róznymi typami aparatów uzywanych do samokontroli.

The self-control is the important item in hypertension treatment. The results of blood pressure measurements were received by using various types using different of oscillometric equipment (thumb, wrist and arm manket) and compared with the outcomes of mercury sphygmomanometer which was used in the same trial. The satisfactory correlation of results from different types of equipment was confirmed with the exception of the thumb oscillometric apparatus results.

[The effect of human recombinant erythropoietin on levels of plasma phospholipids in patients chronically treated with hemodialysis]. / Wplyw ludzkiej rekombinowanej erytropoetyny na stezenie fosfolipidów osocza u chorych przewlekle hemodializowanych.

In uremic patients a disturbed lipid metabolism is observed. In our former works a positive effect of erythropoietin (EPO) on blood platelet phospholipids composition in uremic patients was indicated. In this study we examined the EPO influence on blood plasma phospholipids in chronically hemodialyzed patients. Phospholipids were measured by thin layer chromatography method before and 3 months after the beginning of EPO treatment. EPO was administered subcutaneously, 2000 U twice a week. Decreased phosphatidylethanolamine, phosphatidylinositol and phosphatidylcholine levels were shown in patients before EPO treatment, compares with the control group. During EPO therapy the phospholipid levels approached to normal values. Conclusion is that EPO administration has a positive influence on blood plasma phospholipids in hemodialyzed patients. The detailed importance of this event has been not known yet, but our observations suggest that EPO profoundly interferes with lipid metabolism.

Human erythropoietin improves the blood platelet phospholipid composition in chronically hemodialyzed patients.

Phospholipids play an essential role in platelet structure and function. In uremic patients an abnormal platelet phospholipid pattern is observed. We examined the influence of recombinant human erythropoietin (rhuEPO) on platelet phospholipid composition in hemodialyzed patients. Before rhuEPO therapy, phosphatidylethanolamine, phosphatidylinositol, and phosphatidylcholine were significantly reduced as compared with a healthy control group. After rhuEPO treatment, the phosphatidylethanolamine, phosphatidylinositol, and phosphatidylcholine concentrations showed a significant increase. We conclude that rhuEPO partially normalizes the platelet phospholipid composition in uremia.

[Change of platelet function after the beginning of repeated hemodialysis treatment in patients with uremia]. / Zmiana czynnosci krwinek plytkowych po rozpoczeciu leczenia powtarzanymi hemodializami u chorych z mocznica.

The disturbances of platelet function in end-stage renal failure varies in dialysed and non-dialysed patients. We examined some platelet function in 11 uremic patients treated conservatively (TC) and, again in the same patients, 3-month after the beginning of repeated hemodialysis treatment (HD). The blood samples were taken before hemodialysis. In TC patients normal platelet count, prolonged bleeding time, normal platelet aggregation, unchanged PF4 activity and decreased PF3 availability were shown, compared with control group. In HD patients also normal platelet count and prolonged bleeding time were noted, but increased platelet aggregation, increased PF4 activity and PF3 availability were observed, compared with control group and with TC patients. We conclude that in TC patients rather decreased platelet function was observed; after the beginning of hemodialysis treatment some platelet function became significantly enhanced, which suggests platelet activation. Moreover, in HD patients the disturbances of platelet function before dialysis were shown, then it is possible that platelet activation persists in interdialytic period.

[Distribution of platelet membrane phospholipids in patients chronically hemodialyzed using cuprophane and cellulose acetate membranes]. / Rozmieszczenie fosfolipidów blonowych krwinek plytkowych u pacjentów przewlekle hemodializowanych z uzyciem blon kuprofanowych i z octanu celulozy.

The hemodialysis treatment is associated with a number of untoward events due to the blood-membrane contact. The severity of these reactions depends greatly on the kind of membrane. One of such effects is platelet activation with platelet membrane phospholipid translocation. The aim of this study was to assess the platelet membrane phospholipids distribution during hemodialysis through cuprophane (group I--12 patients) and cellulose acetate (group II--13 patients) membranes. Samples were taken before hemodialysis 14 days after treatment with the same dialyzer type. Phospholipids distribution was determined using a non penetrating tracer (TNBS) and by highly purified phospholipases hydrolysis. In patients of the group I a significant increase of phosphatidylserine and phosphatidylethanolamine at the outer platelet membrane surface was noted, as well as decrease in the other phospholipid classes, compared with control group. In patients of the group II the disturbances of phospholipid distribution were markedly smaller, and concerned only phosphatidylserine and sphingomyelin. Our data indicate that in patients dialyzed with the use of cuprophane membrane the disturbances of platelet membrane phospholipid distribution persist during the dialysis period. The milder intensity of these disturbances in patients treated using cellulose acetate suggests a better biocompatibility of this membrane.